The exact cause of HG is still unknown and many theories
exist. It is, however, a real disease. Too little research
has been done, and that which is done is often inconclusive
or only
identifies commonality
among
half of research participants. What is known is that hormonal
changes, dehydration, nutritional deficiencies, and the overall
stress on the body’s chemistry and functioning contribute
to nausea and vomiting in pregnancy.

The cause is likely due to several factors that may differ
for each woman. Some women may be more likely to vomit due
to genetic differences. It is not a woman's fault, and she
cannot control whether or not she vomits when pregnant, nor can she control the severity of her nausea.
Vomiting is almost always stimulated by a place in the brain
known
as the vomiting center. It may also be stimulated by changes
in the stomach and intestines that are caused by pregnancy.
Emotional distress may worsen vomiting, but is not the cause.
Many causes of hyperemesis are related to the various hormonal
changes of pregnancy to which some women are more sensitive.
Some known causes include the following:

Altered sense of taste

Sensitivity of the brain to motion

Food leaving the stomach more slowly

Increased sense of smell

Insufficient fluids or nutrition

Rapidly changing hormone levels during pregnancy

Stomach contents moving back up from the stomach

Physical and emotional stress of pregnancy on the body

Vitamin deficiencies

2. Will HG happen every time she is pregnant?

Studies vary, but most find that women have a good chance
of experiencing HG in future pregnancies. Statistics suggest
over 50% will have it with each pregnancy, and those with
more than one experience of HG have a greater risk of experiencing
HG in future pregnancies. It also seems to occur in similar
patterns and severity, though it is not always consistent.
Those who have mothers, grandmothers, or sisters who have
had HG will often have at least some nausea and vomiting
during pregnancy.

In most women, it will begin within 2-5 weeks after conception.
The nausea/vomiting will generally ease after the first trimester
and typically stops before a woman reaches 20 weeks gestation,
or around halfway. However, about 10-20% of these women will
find nausea and vomiting last until delivery, though it is
usually less severe. If a woman has had HG in previous pregnancies,
it will often follow a similar pattern of duration and severity.

4. The doctor says there is nothing available
to treat HG. Is that true?

Due to the risk of stating a medication is safe for use
during pregnancy, few if any drug manufacturers will say
their drugs are intended for use during pregnancy or for
a pregnancy condition such as HG. However, due to the misery
and debility women with HG face, physicians will often treat
it with medications deemed safe due to their history of being
used for pregnancy nausea and vomiting for decades (e.g.
Compazine, Phenergan, Unisom).

It is unfortunate that many
health professionals will only consider the older medications,
as they are often found to be less effective than newer
medications (Zofran, Kytril, Reglan). This is especially
true for those
with moderate and severe HG. Newer medications are not
necessarily unsafe, they just don't have as many studies
to demonstrate their safety. The risk of treating a mother
with drugs that are most effective is often less risky than
not treating her. Chronic dehydration and malnutrition worsen
her symptoms and can adversely affect the baby.

Above all, know that effectively treating symptoms early
in pregnancy can make a woman less sick and decrease the
time it takes to recover. Delaying treatment until
she has been vomiting for several weeks makes it harder
to gain control over the vomiting cycle. You have the right
to adequate health care. Consult with another health professional
if needed to get the care she needs. She may need someone to
advocate for her if she is very sick. If she loses more than 10% of her pre-pregnancy weight
and her doctor is unwilling to give her effective medications or
other treatments, it is a good idea to seek a second opinion
from a high-risk obstetrician or perinatologist.

Our Referral Network lists health professionals other women with
HG have recommended or those who have requested to be added.
You will also find information on how to find a practitioner
experienced in treating HG if one is not listed in your
area.

5. She says she is really
sick, but I don't see other pregnant women this sick? Is she exaggerating?

First of all, understand that she is really sick and no
one except those who have had HG will truly understand what
she is experiencing. You may have a better idea if you imagine
having food poisoning
for weeks (or months). Most people know how miserable and
exhausting just a day or two of that is. Also, keep in mind
that women become isolated due to being so ill, and may
become depressed (PDF)
and/or anxious, especially if HG lasts beyond mid—pregnancy
or is very severe. This is not uncommon and not her fault.
If she feels depressed, talk to her and her doctor about
medication or try natural homeopathic remedies. Some medications
have been researched for use during pregnancy after the first
trimester.

Support Groups
Find others who have experienced HG and read their stories. It can be very
helpful to read how others have coped and better understand the reality of HG.

Survival Tips
Print out or refer to our Survival Guide pages for information on what
it is like to experience HG and how you can help. Remember, you
will never completely understand, but you can be supportive anyway.

Coping
Read the pages
on coping for tips on how you can cope with the added stress and responsibility.

How You Can Help Her
Review information specifically for family members and friends on how you can best help a mother with HG cope and survive.

6. I think she has HG. How do I know if
this is more than morning sickness?

If she is vomiting more than a few times a day and losing
weight, she might have HG. If she cannot keep enough water
down to stay hydrated, is vomiting bile or blood, and has
lost more than 1-2 pounds (0.45-0.9 kg) in a week, she likely
has HG. Women with HG often have great difficulty taking
care of their normal responsibilities and/or going to work
for weeks or months. In more severe cases, they may have
trouble even caring for themselves, such as showering and
preparing food. Medical intervention is critical for these
women.

Nausea and vomiting do not significantly limit eating and drinking most days.

Nausea and
vomiting greatly reduce food intake and cause dehydration
if not treated.

Vomiting is
infrequent and the nausea is episodic and not severe,
but may cause discomfort and misery.

Vomiting is
frequent and may contain bile or blood if not treated.
Nausea is usually moderate to severe and constant.

Dietary and/or
lifestyle changes result in improvement most of
the time.

Fluid rehydration
through a vein and/or medications to stop the vomiting
are typically required.

Improvement
is typically gradual after the first trimester,
although occasional queasiness may occur.

Improvement
usually occurs by mid-pregnancy, but nausea and/or
vomiting may last until late pregnancy.

Work and household
tasks may be difficult at times, but usually can
be completed when nausea is less severe.

Outside employment
and home responsibilities may be impossible for
weeks or months. Self-care may also be very difficult.

7. She can't stop vomiting. Should I call
her doctor?

If she cannot keep more than a very small amount of food or
water down for 24 hours or more, loses 2 or more pounds (0.9
kg) in one week, vomits blood, faints, or generally feels very
unwell, call her practitioner. If she has several of these
symptoms and it is after working hours, you may need to take her
to the ER or an urgent care center.

You can buy Ketostix
at a local pharmacy without a prescription. These test
her level of dehydration and starvation. If she has
ketones in her urine (the
test is positive), she will need to get fluids through
an intravenous (IV) line at the doctor's office, ER, hospital,
or an urgent care center. Ketones may be harmful to the
baby
and mom if not treated. If she has been vomiting for several
weeks and eating very little, she will also need vitamins
in her IV. Sometimes this is forgotten, so make sure
you ask about it, it is very important. B-vitamins are most
critical as they are depleted rapidly by vomiting and lack
of eating. Remember, dehydration
and ketones worsen nausea and vomiting and need to be monitored
closely.

Call her health professional if she experiences any of the
following:

Abdominal pain, bleeding, or cramping

Difficulty thinking or focusing

Difficulty walking or talking

Extreme fatigue and very low energy

Little if any food or fluids stay down for over 24 hours

Little saliva and a dry mouth

Moderate or severe headache and/or fever

Muscular weakness or severe cramping

Repeated vomiting or retching daily

Severe nausea that keeps you from eating/drinking

Shortness of breath or dizziness

Urination is infrequent (over 8 hours) and minimal amount

Urine is dark yellow and concentrated

Visual disturbances, or fainting

Vomit is red with blood or yellow with bile

Weight loss of 2 pounds (0.9 kg) or more in a week

8. She had HG in her last pregnancy. Can
we prevent it from happening again?

Since the exact cause is not known and is likely due to
more than one factor, it is not preventable. However, the
symptoms are often more manageable and less severe if adequate
treatment is given early in pregnancy. Sometimes women find
HG may be less severe if they plan
ahead and prepare for
pregnancy. This includes eating very healthy, taking antioxidants
and prenatal
vitamins for several months, and making sure she is in the
best health possible. Underlying conditions such as gall
bladder disease can worsen HG. Finding a health professional
experienced in treating HG and who knows her history is
crucial. Make a plan based on what worked for her last pregnancy
and find a health professional willing to give her get the
care she needs.

9. She can't eat or take any vitamins,
and she has lost a lot of weight. Will this hurt the baby?

In most cases, women who lose weight during their first
trimester have normal babies. Adequate nutrition is important
for the baby, but fetal requirements are minimal during
the first few months. Her body should have sufficient stores
for the baby during this time. High-quality vitamins can
be helpful for most women, but those with HG often cannot
tolerate them, especially if they contain iron. Studies show
vitamins seem to be most critical during the few months prior
to pregnancy and up to about 6 weeks gestation. This is when
the risk of miscarriage is great and the spine is forming.
Folic acid and antioxidant requirements are greatest at this
point according to these studies. Since HG often does not
make vitamins completely intolerable until around this time,
just encourage her to take them as long as you can. She can
try sublingual (under the tongue) forms of vitamins (especially
B and folic acid) that can be ordered online or found at
some health food stores. If she is admitted for IV fluids,
make sure a multivitamin is added to her fluids, especially
if she has been vomiting frequently for more than 2 weeks.
This is not routinely done, unfortunately.

The risk to the baby is greatest if the mother is dehydrated
for extended periods of time, loses 10% or more of her pre-pregnancy
weight and does not receive vitamins or other nutritional
support, or fails to gain weight for 2 consecutive trimesters.
Obviously, if the mother develops other complications, they
also present an increased risk. Most studies, however, show
that women with hyperemesis have normal babies unless they
are severely ill and receive little treatment.

10. Her health professional offered a prescription
medication, but will it hurt the baby?

There is always a risk with any medication taken during
pregnancy. However, medications most often prescribed typically
present less risk to the mother and child than chronic dehydration
and lack of nutrition. The risk decreases after the first
trimester or around 10 weeks, but if vomiting is left uncontrolled
until then, the stress on the body is great and it is much
more difficult to stop the vomiting. These women are then
at greater risk for complications and a prolonged recovery.
They often will have great difficulty caring for themselves
and their family for months. Medications are often more effective
if started early because there are fewer nutritional deficiencies
and the mother is in better overall health. It can be compared
to pain control. Most health professionals know that when
pain medicine is given early for pain, rather than later,
the pain is easier to control. The same holds true with vomiting.
The consequences and complications are typically less if
the nausea and vomiting are controlled earlier than later.